Ou Haiya, Zhuang Jiamei, Jian Mingwei, Zheng Xinyi, Wu Tingping, Cheng Honghui, Qian Rui
Department of Gastroenterology, Shenzhen Bao'an Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China.
Department of Nephrology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China.
Front Oncol. 2025 Mar 6;15:1432596. doi: 10.3389/fonc.2025.1432596. eCollection 2025.
To report the latest systematic review and meta-analysis of randomized controlled trials (RCT) to compare perioperative versus adjuvant chemotherapy for resectable gastric cancer.
We conducted a systematic literature retrieval via PubMed, Embase, Web of Science, and Cochrane until April, 2024 for RCT which compared perioperative versus adjuvant chemotherapy for resectable gastric cancer. Outcomes measured were overall survival (OS) and progression-free survival (PFS).
5 RCTs including 2,735 patients were included for meta-analysis. Meta-analysis revealed a significant longer PFS in the neoadjuvant chemotherapy (NAC) group (HR: 0.77; 95% CI: 0.69, 0.85; <0.00001) compared with adjuvant chemotherapy (AC) group. Subgroup analysis found that there was still a significant superiority of NAC in female (HR: 0.53; 95% CI: 0.40, 0.70; <0.0001) and cN+ (HR: 0.77; 95% CI: 0.67, 0.89; =0.0005) patients, while the superiority disappeared in male (HR: 0.87; 95% CI: 0.74, 1.01; =0.07) and cN- patients (HR: 0.91; 95% CI: 0.46, 1.78; =0.77). In addition, meta-analysis observed a trend towards improved OS with NAC (HR: 0.86; 95% CI: 0.70, 1.07; = 0.17), and sensitivity analysis demonstrated instability in OS.
NAC can significantly prolong PFS in patients with resectable gastric cancer compared to AC, and the benefit is more significant in women and cN+ patients. Besides, our analysis indicated that NAC has a potential to improve OS compared with AC.
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024546165.
报告最新的关于比较可切除胃癌围手术期化疗与辅助化疗的随机对照试验（RCT）的系统评价和荟萃分析。
我们通过PubMed、Embase、Web of Science和Cochrane进行了系统的文献检索，直至2024年4月，以查找比较可切除胃癌围手术期化疗与辅助化疗的RCT。测量的结局指标为总生存期（OS）和无进展生存期（PFS）。
纳入5项RCT（共2735例患者）进行荟萃分析。荟萃分析显示，与辅助化疗（AC）组相比，新辅助化疗（NAC）组的PFS显著更长（HR：0.77；95%CI：0.69，0.85；<0.00001）。亚组分析发现，NAC在女性患者（HR：0.53；95%CI：0.40，0.70；<0.0001）和cN+患者（HR：0.77；95%CI：0.67，0.89；=0.0005）中仍具有显著优势，而在男性患者（HR：0.87；95%CI：0.74，1.01；=0.07）和cN-患者（HR：0.91；95%CI：0.46，1.78；=0.77）中优势消失。此外，荟萃分析观察到NAC有改善OS的趋势（HR：0.86；95%CI：0.70，1.07；=0.17），敏感性分析显示OS存在不稳定性。
与AC相比，NAC可显著延长可切除胃癌患者的PFS，且在女性和cN+患者中获益更显著。此外，我们的分析表明，与AC相比，NAC有改善OS的潜力。
